Systematic review: the management of hepatic cyst infection

Lantinga, Marten A.; Geudens, A.; Gevers, Tom J.G.; Drenth, Joost P.H.

doi:10.1111/apt.13047

Cited by 30 publications

(31 citation statements)

References 19 publications

(36 reference statements)

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“…Indeed, while CyH treatment most often relies on painkillers and expectant management, CyI requires an early and prolonged antibiotherapy, with inherent exposure to side-effects and cost [ 11 , 24 ]. Furthermore, liver pyocyst should be drained in case of resistance to well-conducted antibiotherapy and/or rapid relapse[ 25 , 26 ]. Mortality is mostly linked to liver CyI [ 13 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Algorithm in the Management of Acute Febrile Abdomen in Patients with Autosomal Dominant Polycystic Kidney Disease

et al. 2016

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BackgroundAcute febrile abdomen represents a diagnostic challenge in patients with autosomal dominant polycystic kidney disease (ADPKD). Although criteria have been proposed for cyst infection (CyI) and hemorrhage (CyH), there is a lack of comparative assessments. Furthermore, distinguishing cystic from non-cystic complications remains problematic.DesignADPKD patients presenting with abdominal pain and/or fever between 01/2005 and 06/2015 were retrospectively identified in a systematic computerized billing database. CyH was defined as spontaneous intracystic density above 50 Hounsfield units on computed tomography (CT). CyI was definite if confirmed by cyst puncture, and probable if 4 criteria were met: 3-day fever, loin/liver tenderness, C-reactive protein (CRP) plasma levels >50mg/L and no CT evidence for CyH. Other episodes were grouped as inflammation of unknown origin (IUO).ResultsAmong a cohort of 173 ADPKD patients, 101 presented with 205 episodes of abdominal pain (n = 172) and/or fever (n = 33). 20 patients experienced 30 CyH, whereas 16 presented 23 episodes of definite (n = 11) or probable (n = 12) CyI. 35 IUO were observed in 31 patients. Clinically, fever was observed in 7% vs. 100% vs. 66% of CyH, CyI and IUO, respectively. Biologically, CRP cut-off at 70 mg/dl showed 92% sensitivity and 81% specificity in CyI diagnosis. Urine or blood cultures remained sterile in >90% of CyH, but were contributive in 53.4% of CyI and IUO, with a 74.2% prevalence for E. coli. Radiologically, ultrasounds, CT and magnetic resonance diagnosed CyI in 2.6%, 20% and 16.7% of cases, respectively. 18F-FDG positron-emission tomography (PET)/CT was done within a median period of 7 days post antibiotics, and significantly changed patient management in 71.4%.ConclusionsThis retrospective single-center series underscores the usefulness of clinical–fever–and biological–CRP–parameters, but emphasizes the limitations of bacteriological and radiological investigations in cases of acute febrile abdomen in ADPKD patients. 18F-FDG-PET/CT imaging may be helpful in such condition.

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Section: Discussionmentioning

confidence: 99%

“…Furthermore, liver pyocyst should be drained in case of resistance to well-conducted antibiotherapy and/or rapid relapse[ 25 , 26 ]. Mortality is mostly linked to liver CyI [ 13 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Algorithm in the Management of Acute Febrile Abdomen in Patients with Autosomal Dominant Polycystic Kidney Disease

et al. 2016

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“…Even if infection of the remnant cavity occurs, it can be remitted by oral Ciprofloxacin (500 mg twice daily) associated or not with clindamycin (300 mg three times daily) [42]. Oral ciprofloxacin is also indicated as the first line treatment in infected cysts [43].…”

Section: Percutaneous Treatmentmentioning

confidence: 99%

Diagnostic and Therapeutic Challenges in Nonparasitic Liver Cysts

Boeți¹,

Boroș²,

Herlea³

et al. 2015

Recent Advances in Liver Diseases and Surgery

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Nonparasitic hepatic cysts constitute a heterogeneous group of disorders. " proper diagnosis of hepatic cyst is necessary in order to adopt the best treatment. The term hepatic cyst usually refers to simple hepatic cysts. Nonparasitic hepatic cysts are also linked to genetic disorders such as polycystic liver disease PLD with/ without autosomal dominant polycystic kidney disease "DPKD or Caroli disease.Generally, patients with nonparasitic hepatic cysts less than cm are asymptomatic. These cysts become symptomatic when are large, multiple, or complicated.Percutaneous abdominal ultrasound is the best imaging modality to diagnose hepatic cysts but must be completed by other imaging and serological tests. It is important to differentiate simple hepatic cyst from hydatid cyst, cystadenoma, and cystadenocarcinoma before proceeding with the treatment. Sometimes the diagnosis is very challenging. "symptomatic single liver cysts need only surveillance, but symptomatic and complicated ones require therapeutic intervention.Percutaneous aspiration of the cyst under ultrasound guidance is a mini-invasive procedure generally associated with sclerotherapy. The highest success rates were reported for laparoscopic or open cyst fenestration. Liver transplantation is indicated for patients with severe PLD.

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“…It is far less frequent than renal cyst infection but more severe and involving multiple and larger cysts [2]. Recurrences are also common, affecting 20% of patients in Lantiga's metaanalysis [3].…”

Section: Introductionmentioning

confidence: 99%

Liver cyst infection in kidney transplant patient with autosomal dominant polycystic kidney disease: Interest of PET/CT in diagnosis and treatment

H*¹

2018

J Clini Nephrol

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Liver cyst infection in patients with autosomal dominant polycystic kidney disease (ADPKD) is a rare but life-threatening complication. Diagnosis and treatment remain challenging. We report the case of a 64-year-old kidney transplant patient presenting with fever and abdominal pain. The diagnosis of liver cyst infection was made by positron emission tomography scan (PET/CT). Moreover, the course of our patient illustrates the interest of subsequent PET/CT during follow-up as our patient failed on antibiotherapy and required liver cyst drainage.

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Systematic review: the management of hepatic cyst infection

Abstract: SUMMARY BackgroundCyst infection is a severe complication of hepatic cystic disease. However, an evidence-based treatment strategy is not available.

Cited by 30 publications

References 19 publications

Diagnostic Algorithm in the Management of Acute Febrile Abdomen in Patients with Autosomal Dominant Polycystic Kidney Disease

Diagnostic Algorithm in the Management of Acute Febrile Abdomen in Patients with Autosomal Dominant Polycystic Kidney Disease

Diagnostic and Therapeutic Challenges in Nonparasitic Liver Cysts

Liver cyst infection in kidney transplant patient with autosomal dominant polycystic kidney disease: Interest of PET/CT in diagnosis and treatment

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